Gender Differences In The Consequences Of Substance Abuse

It is generally presumed that alcohol and drug abuse will produce more deleterious consequences among women than among men. This expectation is grounded both in biological differences and in social-role expectations.

From a biological standpoint, it is frequently noted that the lower ratio of water to total body weight in women causes them to metabolize alcohol and drugs differently than men. Even when body weight is controlled, given equivalent alcohol consumed, women pass more alcohol into the bloodstream and reach higher peak Blood Alcohol Concentrations than men, in part because of differences in enzyme activity in the intestinal wall. Drugs such as marijuana that are deposited in body fat may be slower to clear in women than in men. Slow clearance rates create a potential for cumulative toxicity and adverse drug and alcohol interactions.

The behavioral telescoping of women's uncontrolled drinking and drug use is paralleled by a telescoping of some physical health consequences of alcohol and drug use. Alcoholic liver disease progresses more rapidly in women compared with men. Women also seem to be more prone to alcohol-related brain damage. They show physical brain abnormalities after a shorter drinking history and at lower peak alcohol consumption. Women also exhibit cognitive deficits on psychological tests of memory, speech, and perceptual accuracy with a shorter drinking history than that of men.

Women diagnosed as alcoholic have very high mortality rates relative to both the general population of women and to alcoholic men. A follow-up study of alcoholic women in St. Louis, found that, 11 years after treatment, they had lost an average of 15 years from their expected life span. Another study of 1,000 female and 4,000 male alcoholics in Sweden found the excess mortality was higher for the women (5.2 times the expected rate) than for the men (3 times the expected rate).

Deaths due to drugs other than alcohol and tobacco are relatively uncommon among women. Men are far more likely than women to die from drug use. The higher male death rates are largely explained by males' greater drug use rather than by sex differences in vulnerability among drug users. In 1990, medical examiners in twenty-seven U.S. metropolitan areas reported 5,830 deaths involving illicit and/ or legally obtained drugs. Of those who died from drug-related causes (e.g., Overdose, accidental injury), 71 percent were male.

The HIV virus that causes AIDS is transmitted primarily via infected blood and semen. Sharing needles and having sexual relations with intravenous (IV) drug users places both men and women at risk for contracting that incurable disease. Although most AIDS cases have resulted from transmission of HIV during intimate sexual contact between men, about 12,000 of the 43,000 people reported to have AIDS in 1990 were IV drug users. Most of these AIDS cases involving IV drug use were male. When women contract AIDS, the most common route of transmission is through their own IV drug use or sexual contact with a partner who is an IV drug user.

Women's reproductive function increases alcohol- and drug-related health risks to themselves and to their unborn children. Alcohol and drug abuse are associated with numerous disorders of the female reproductive system, including breast cancer, amenorrhea, failure to ovulate, atrophy of the ovaries, miscarriage, and early menopause. Men also experience reproductive and sexual difficulties as a result of alcohol and drug abuse, including impotence, low testosterone levels, testicular atrophy, breast enlargement, and diminished sexual interest.

Infants born to women who used alcohol, tobacco, or other drugs during Pregnancy can experience numerous health problems, including low birth weight, major congenital malformations, neurological problems, mental retardation, and withdrawal symptoms. Although substance abuse at any time during pregnancy can cause birth defects, the very rapid cell division in the first weeks of embryonic development means the teratogenic effects of alcohol and drugs are generally greatest early in pregnancy, before a woman even realizes she is pregnant.

As the medical and social costs of prenatal alcohol and drug exposure become more apparent, so does public pressure for action. Many advocate termination of parental rights in cases where a newborn tests positive for drug or alcohol exposure. In some jurisdictions, mothers who used alcohol or drugs during pregnancy have been charged with child abuse or delivering a controlled substance to a minor. Critics of these policies charge that alcohol and drug screening will discourage substance-abusing women from obtaining necessary prenatal care. Legally, it may be difficult to establish criminal intent if substance abuse occurred early in an unintended and unrecognized pregnancy. Further, it is often difficult to causally disentangle alcohol or drug effects from other adverse conditions the mother may have experienced, such as poor nutrition, acute or chronic illness, and inadequate prenatal care. As currently practiced, prenatal drug-use detection procedures raise important questions of fairness. Hospitals and clinics serving largely poor and minority patient populations are more likely to detect prenatal substance abuse despite evidence that substance abuse occurs in all socioeconomic categories.

The tendency of female problem drinking and drug abuse to develop in a relationship with a substance-abusing male partner may shield women from some consequences of their substance abuse. For example, women alcoholics and addicts are less vulnerable to arrest if their partner procures drugs for the couple or drives when they are intoxicated. On the other hand, substance-abusing partners increase some other risks for alcohol- and drug-dependent women compared with men. Women with substance-abusing partners are vulnerable to domestic Violence. Also, a substance-abusing partner can be an impediment to women's seeking or complying with alcohol and drug treatment.

Despite women's biophysical vulnerability and the stigma associated with female alcohol and drug abuse, men are more likely than women to experience some problems related to heavy drinking and illicit drug use. Substance abuse is more strongly related to intrapsychic problems among women, and to problems in social functioning (employment difficulties, financial problems, unsafe driving, arrest) among men.

These gender differences may be related to sex-role differences in drinking and drug use. Male substance use is less socially controlled—occurring more often in recreational contexts, public places, and all-male settings—whereas female substance use is more likely to occur in the home, with a male partner, and under medical auspices. Sex roles may also allow males to exercise less personal control while drinking or using drugs. For example, male episodes of intoxication are more often associated with rapid ingestion, blackouts, and Aggression.

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